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Geriatrics Flashcards

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1
Q

What is frailty?

A

Diminished strength, endurance and physiological function that increases an individuals vulnerability for developing increased dependency or death

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2
Q

Frailty phenotype model?

A

Unintentional weight loss
Weakness evident by poor grip strength
Self-reported exhaustion
Low levels of physical activity

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3
Q

How is degree of frailty assessed?

A

Rockwood frailty Index

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4
Q

Physiological markers of frailty?

A 
Increased inflammatory markers 
Elevated insulin and glucose in fasting state 
Low albumin 
Raised D-dimer + Alpha Antitrypsin 
Low Vit D
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5
Q

What is included in the comprehensive geriatric assessment?

A 
Physical health 
Mental health 
Functional ability 
Social circumstances 
Environment
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6
Q

What is the comprehensive geriatric assessment?

A

Evidence based approach to identify health problem and establish management plans in older frail patients

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7
Q

4 physical assessment scales?

A

Barthel Index
Berg Balance test
Nottingham Extended ADL
Timed up and go test

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8
Q

5 mental assessment scales?

A 
Abbreviated mental test 
Montreal Cognitive Assessment 
Mini mental state exam 
Geriatric depression scale 
Confusion Assessment Method
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9
Q

How do you assess malnutrition in the elderly?

A

BMI + Malnutrition Universal Screening Tool

BMI, Unexpected weight loss, acutely ill or no food for >5 days

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10
Q

What is re-feeding syndrome?

A

Metabolic abnormalities that occur when a patient begins eating again after a period of starvation or limited intake
- In particular low levels of phosphorus

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11
Q

Mechanism of re-feeding syndrome?

A

When eating after starvation, insulin is increased and so is BMR using up all the electrolytes such as phosphates, magnesium and potassium + intracellular movement of electrolytes causes further depletion

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12
Q

Cardiogenic causes of falls?

A

Arrhythmia

Structural Heart Disease

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13
Q

What is orthostatic hypotension?

A

When standing for 3 mins SBP drops by 20 or DBP drops by 10. Failure of compensatory mechanisms

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14
Q

Pharmacological management of orthostatic hypotension?

A

Fludrocortisone or Midodrine

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15
Q

Reflex syncope?

A

Inappropriate cardiovascular response of vasodilation or bradycardia leading to cerebral hypoperfusion
e.g. Vasovagal, Situational, Carotid sinus syndrome

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16
Q

Causes of postural hypotension?

A

Diuretics
Alpha/ Beta blocks
Aortic stenosis
Heart Failure

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17
Q

Complications of the long lie?

A

Loss of independence, Decreased confidence, Internal bleeding, Rhabdomyolysis, Hypothermia, Pneumonia, Pressure Sores

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18
Q

Pressure ulcer?

A

Injuries to the skin or underlying tissue primarily caused by prolonged pressure on the skin

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19
Q

Mechanism of a pressure ulcer?

A

Localised external pressure on skin causes occlusion of the arteries and tissue compression

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20
Q

Stage 1 pressure ulcer?

A

Non-blanching Erythema

Skin is intact and non-blanchable redness is localised to a bony prominence

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21
Q

Stage 2 pressure ulcer?

A

Loss of dermis appearing as a shallow open ulcer or fluid filled blister

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22
Q

Difference between stage 3 + stage 4 full-thickness?

A

Loss of SC fat but in stage 4 the bone, tendon or muscles may be exposed and has a greater risk of osteomyelitis

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23
Q

Suspected deep tissue injury?

A

Deep blood-filled blister with intact skin

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24
Q

Moisture lesion

A

Redness/ partial thickness involving the dermis/epidermis caused by excessive moisture from urine, faeces or sweat

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25
Risk assessment tools for pressure ulcers?
Waterlow Pressure Ulcer Policy | Braden Pressure Ulcer Risk Assessment
26
SSKIN?
``` Surface support Skin Keep Moving Incontinence Nutrition + Hydration ```
27
When are systemic abx prescribed in a patient with pressure ulcers?
Sepsis Cellulitis Osteomyelitis
28
Common cause of community-acquired pneumonia?
Strep Pneumonia Mycoplasma pneumonia Influenzae A
29
Common cause of pneumonia in COPD?
Haemophilus Influenzae
30
Common cause of pneumonia in IVDU?
Staphy Aureus | Mycobacterium Tubercluosis
31
Common cause of hospital-acquired pneumonia?
Pseduomondas Aeruginosa or MRSA
32
How do you assess the severity of CAP?
``` CURB-65 Confusion Urea >7 RR>30 BP <90/60 >65 1 or less - Outpatient treatment 2 - admit 3 - ITU ```
33
Complications of pneumonia?
Lung abscess Empyema Sepsis ARDS
34
Basal ganglia?
Collection of nerve cells located at the base of the cerebrum deep in the brain that smooth out, coordinate and initiate movement
35
Complications of Parkinson's?
``` Autonomic dysfunction Motor involuntary movements On-off phenomenon Freezing of gait Falls Aspiration pneumonia Pain sleep disturbances Pressure ulcers Daytime sleepiness Behaviour change - Gambiling, hypersexuality ```
36
Early signs of Parkinson's?
Mood changes Ansomia Acting out dreams during their sleep Visual/ Auditory hallucinations
37
Diagnosis of Parkinson's?
MRI | DAT scan
38
MOA of levodopa?
Combines with DOPA decarboxylase and cross the BBB. Then is converted to Dopamine to stimulate dopaminergic receptors
39
MOBI?
Inhibits the enzyme that normally breaks down dopamine | e.g. Selegiline, Rasagiline, Safinamide
40
Why is cabergoline not recommended as a dopamine agonist for Parkinson's?
Risk of cardiac Fibrosis
41
What group of medications are more effective for managing excessive sleepiness, hallucinations and impulse control in Parkinson's disease?
Dopamine agonists Pramipexole Ropinirole Rotigotine
42
Symptoms of Parkinson's?
``` Tremor Rigidity Akinesia Postural Instability Bradykinesia ```
43
Osteoporosis?
When BMD is >2.5SD below the peak mass. Increased risk of fragility fracture due to increase osteoclast activity
44
Risk factors of osteoporosis?
``` Female Menopause Corticosteroid use Rheumatoid arthritis IBD Chronic liver disease BMI<18.5 ```
45
FRAX score?
Risk of fracture over a period of 10 years in a patient with osteoporosis
46
What specialist test can be used to estimate bone turnover?
Serum C telopeptide
47
Management of osteoporosis?
Bisphosphonates Calcium + Vit D HRT in premenopausal women Lifestyle changes
48
SE of bisphosphonates?
Nausea, Gastritis, Oesophageal bleeds, Osteonecrosis of the Jaw, Bone/ Muscle/ Joint Pain, Atypical stress fracture
49
Types of incontinence?
``` Stress Urge Mixed Bladder outlet obstruction (Overflow) Fistula Functional incontinence ```
50
Stress incontinence?
Weakness of the urinary outlet
51
Urge incontinence?
Failure of the bladder to store urine due to high bladder pressure
52
Functional incontinence?
Incontinence due to general impairment e.g. cognitive, functional, affective
53
Examination of a patient presenting with incontinence?
Mental - cognitive assessment Cardioresp - Signs of chronic respiratory disease or HF Abdo - kidneys or bladder enlarge, PR exam Pelvis - Vaginal atrophy or prolapse, pelvic floor strength, cough Neuro - Gait, sensation of lower limbs and pelvis
54
Medication and Urinary incontinence
``` Alcohol - Polyuria ACEi - Cough + stress incontinence Anticholinergic - Retention + overflow Diuretic - polyuria, frequency, urgency Opiate - Retention, constipation, sedation TCA - Retention + Overflow ```
55
Investigation of incontinence?
Urinalysis Mid stream urine for culture, microscopy + sensititivity Post-void bladder scan Bladder diary
56
Causes of stress incontinence?
Instrumentation during birth or Pelvic floor damage Vaginal prolapse Post-prostectomy in men
57
Management f stress incontinence?
Lifestyle changes Pelvic floor exercises Duloxetine - SNRI Mid-urethral sling insertion (Tension free vaginal tape)
58
What is polypharmacy?
Being prescribed more than 4 medications
59
Consequences of polypharmacy?
Increased morbidity + mortality Increased hospital admission length Reduced compliance Increased risk of adverse drug reactions
60
Types of constipation?
Hard stool in the rectum - faecal impaction which can lead to overflow diarrhoea Whole distal colon - loaded with soft putty like faeces High Impaction - Caused by obstructive lesion
61
The effect of ageing on the bowel?
Decreased motility Decreased peristaltic speed and strength Weak connective tissue - Diverticula Increased sensory threshold - urge to open bowels
62
Investigations of constipation?
PR exam Bloods - FBC, U+E, TFT Abdo X-ray Other - colonscopy, CT abdomen, Barium enema
63
Management of constipation?
``` Rehydration, Mobilisation, High fibre, Med Review Docusate Macrogol/ Lactulose (softening) Senna Enema or Manual evacuation ```

Phase 3a (8 decks)

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